DOCSLIB.ORG

Posttransplantation Lymphoproliferative

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Posttransplantation Lymphoproliferative Original article JeongKorean HJ, J Pediatr et al. • 2017;60(3):86-93 Posttransplantation lymphoproliferative disorder after pediatric solid organ transplantation https://doi.org/10.3345/kjp.2017.60.3.86 pISSN 1738-1061•eISSN 2092-7258 Korean J Pediatr Posttransplantation lymphoproliferative disorder after pediatric solid organ transplantation: experiences of 20 years in a single center Hyung Joo Jeong, MD1, Yo Han Ahn, MD2, Eujin Park, MD1, Youngrok Choi, MD3, Nam-Joon Yi, MD, PhD3, Jae Sung Ko, MD, PhD1, Sang Il Min, MD, PhD3, Jong Won Ha, MD, PhD3, Il-Soo Ha, MD, PhD1, Hae Il Cheong, MD, PhD1, Hee Gyung Kang, MD, PhD1 1Department of Pediatrics, Seoul National University College of Medicine, Seoul, 2Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, 3Department of Surgery, Seoul National University College of Medicine, Seoul, Korea Purpose: To evaluate the clinical spectrum of posttransplantation lymphoproliferative disorder (PTLD) Corresponding author: Hee Gyung Kang, MD, PhD after solid organ transplantation (SOT) in children. Department of Pediatrics, Seoul National University Children’s Hospital, 101 Deahangno, Jongno-gu, Methods: We retrospectively reviewed the medical records of 18 patients with PTLD who underwent Seoul 03080, Korea liver (LT) or kidney transplantation (KT) between January 1995 and December 2014 in Seoul National Tel: +82-2-2072-0658 University Children’s Hospital. Fax: +82-2-2072-0274 Results: Eighteen patients (3.9% of pediatric SOTs; LT:KT, 11:7; male to female, 9:9) were diagnosed as E-mail: [email protected] having PTLD over the last 2 decades (4.8% for LT and 2.9% for KT). PTLD usually presented with fever or Received: 29 August, 2016 gastrointestinal symptoms in a median period of 7 months after SOT. Eight cases had malignant lesions, Revised: 21 October, 2016 and all the patients except one had evidence of Epstein-Barr virus (EBV) involvement, assessed by using Accepted: 25 October, 2016 in situ hybridization of tumor tissue or EBV viral load quantitation of blood. Remission was achieved in all patients with reduction of immunosuppression and/or rituximab therapy or chemotherapy, although 1 patient had allograft kidney loss and another died from complications of chemotherapy. The first case of PTLD was encountered after the introduction of tacrolimus for pediatric SOT in 2003. The recent increase in PTLD incidence in KT coincided with modification of clinical practice since 2012 to increase the tacrolimus trough level. Conclusion: While the outcome was favorable in that all patients achieved complete remission, some patients still had allograft loss or mortality. To prevent PTLD and improve its outcome, monitoring for EBV infection is essential, which would lead to appropriate modification of immunosuppression and enhanced surveillance for PTLD. Key words: Posttransplantation lymphoproliferative disorder, Solid organ transplantation, Pediatric recipient, EBV viral load monitoring, Tacrolimus Introduction Posttransplant lymphoproliferative disorder (PTLD) is a well-known, potentially fatal complication of solid organ transplantation (SOT) with high mortality (30%–60%)1). The incidence of PTLD in SOT recipients varies from 1% to 13% depending on the type of Copyright © 2017 by The Korean Pediatric Society allograft, ages of recipients and the length of follow-up2,3). The majority of PTLD cases are associated with Epstein-Barr virus (EBV) infection, either primary infection or reactivation This is an open-access article distributed under the 4) terms of the Creative Commons Attribution Non- due to immunosuppression . Risk factors of PTLD include EBV-naïve recipients with EBV- Commercial License (http://creativecommons.org/ positive donors, younger age at SOT, more aggressive immunosuppression, and within the licenses/by-nc/4.0/) which permits unrestricted non- 5) commercial use, distribution, and reproduction in any first year of SOT . medium, provided the original work is properly cited. 86 https://doi.org/10.3345/kjp.2017.60.3.86 Korean J Pediatr 2017;60(3):86-93 In pediatric allograft transplantation, PTLD is relatively common Results because the recipients are often EBV seronegative at the time of transplantation5). As Korean experience, Heo et al.6) had reported 5 1. Characteristics of PTLD patients (Table 1) cases of PTLD among 41 pediatric liver allograft recipients (12.2%) Over the last 2 decades (January 1995 to December 2014), 18 in 2004. Another study of 43 Korean PTLD cases reported 12 pedi- patients (LT:KT, 11:7) were diagnosed with PTLD, rendering the atric cases, but the incidence among pediatric SOT recipients was incidence of PTLD 4.8% for pediatric LT (of total 230 recipients) not described7). Recently, our center has experienced several con- and 2.9% for pediatric KT (of 234 cases). For these PTLD cases, secutive cases of pediatric PTLD, which lead us to review the median age at transplantation was 11 months (range, 3 months to clinical spectrum of PTLD in pediatric SOT recipients. In this study, 18 years) and PTLD was diagnosed at median 7 months (range, 2 we present our experience of pediatric PTLD of 20 years. to 98 months) after SOT, mostly during the first year (n=14, 77.7%), at their median age of 51 months (range, 10 months to 18 years). KT patients with PTLD were older at SOT (median age, 76 Materials and methods months; range 44 months to 13 years) than LT recipients (median age, 7 months; range, 3 to 18 months) on their diagnosis of PTLD. We retrospectively reviewed the medical records of PTLD cases All patients with PTLD were taking tacrolimus targeting trough among pediatric SOT recipients of liver (LT) or kidney transplanta- levels of 10–15 mg/mL in immediate postoperation periods, then tion (KT) that had been performed from January 1995 to Decem- 6–8 mg/mL (before 2012) or 8–10 mg/mL (since 2012) for KT and ber 2014 at Seoul National University Children’s Hospital. The 5–8 ng/mL for LT. Basiliximab was administered in eight patients study was approved by the Institutional Review Boards of our as induction immunosuppression, and 6 of LT patients with PTLD center (IRB#H-1312-068-541). PTLD was clinically suspected were treated for acute rejection before diagnosis of PTLD. EBV when SOT recipients presented persistent lymphadenopathy or tumorous lesions, which were confirmed pathologically and classi- Table 1. Characteristics of patients (n=18) ied following the classification of the World Health Organi zation Characteristic Value 8) system . We categorized the patients into the malignant group and Sex the benign group according to the pathology. Early PTLD was Male:female 9:9 5) defined as PTLD occurring within the first year of SOT . EBV asso- Organ transplanted ciation was assessed in tissue specimens by in situ hybridization Liver:kidney 11:7 of Epstein-Barr virus encoded RNA. EBV viral loads in the patients Age at transplantation 11 mo (3 mo–18 yr) were measured by real-time polymerase chain reaction of EBV Donor type DNA in the peripheral blood of the patients. Deceased 3 (16.7) Characteristics of the patients were reviewed as follows: clinical Living related 15 (83.3) features at the time of transplantation (underlying disease, trans- Prophylactic basiliximab* 8 (44.4) planted organ, age at transplantation, EBV serologic status of the Rejection history and treatment 6 (33.3) donor and the recipient at transplantation, Human Leukocyte Steroid 3 Antigen [HLA] typing); posttrans plantation history (rejection Increasing Immunosuppressant 2 episode, immunosuppressive treat ment, cytomegalovirus [CMV] Re-TPL 1 reactivation status); and charac teristics of PTLD (clinical presenta- Age at PTLD 4 yr (10 mo–18 yr) tion, histopathologic diagnosis, expression of CD20 on tumor cells, Time since transplantation 7 mo (2 mo–98 mo) detection of EBV in tumor cells, stage, treatment, outcome, graft Early:late 14:4 survival, overall survival [OS]). OS is defined as the duration from EBV serologic status (recipient/donor) diagnosis of PTLD to the last follow-up or death. Clinical staging was performed retrospec tively according to the Ann Arbor staging EBV VCA IgG(-/+) 3 (16.7) system for lymphoma9). EBV VCA IgG(-/NA) 4 (22.2) Differences between PTLD patient subsets were assessed by chi- EBV VCA IgG(+/+) 4 (22.2) square test for categorized variables and Welch-Aspin test for EBV VCA IgG(+/NA) 1 (5.6) continuous variables. A P value of less than 0.05 was considered EBV VCA IgG(NA/+) 4 (22.2) statistically significant. The statistical analysis was performed EBV VCA IgG(NA/NA) 2 (11.1) using IBM SPSS Statistics ver. 23.0 (IBM Co., Armonk, NY, USA). Values are presented as number, median (range), or number (%). TPL, transplantation; PTLD, posttransplantation lymphoproliferative disorder; EBV, Epstein-Barr virus; VCA, viral capsid antigen; NA, not available. *All done for acute rejection prophylaxis right after transplantation. https://doi.org/10.3345/kjp.2017.60.3.86 87 Jeong HJ, et al. • Posttransplantation lymphoproliferative disorder after pediatric solid organ transplantation Table 2. Characteritics of PTLD patients before and after 2012 Variable Before 2012 (n=9) After 2012 (n=9) P value Sex Male:female 5:4 4:5 0.637* Transplanted organ Liver:kidney 8:1 3:6 0.016* Age at transplantation 7 mo (3 mo–53 mo) 71 mo (8 mo–18 yr) 0.032† Age of PTLD 1 yr (10 mo–5 yr) 6 yr (1 yr–18 yr) 0.027† Time since transplantation 7M (3 mo–5 yr) 8 mo (2 mo–8 yr) 0.724† Tacrolimus dosage (mg/kg/day) 0.154 (0.037–0.526) 0.222 (0.034–0.889) 0.552† Basiliximab prophylaxis 1 (11.1) 7 (77.8) 0.004* History of acute rejection 3 (33.3) 3 (33.3) 1.000* Ann Arbor stage ≥III 5 (55.6) 6 (66.7) 0.629* B symptoms‡ 4 (44.4) 6 (66.7) 0.343* GI involvement 7 (77.8) 4 (44.4) 0.147* Extranodal involvement 7 (77.8) 5 (55.6) 0.317* Early lesion:malignancy 4:3 (44.4:33.3) 1:5 (11.1:55.6) 0.114* : 0.343* EBV viral load (copies/mL) 261,159 (1,830–3,506,000) 166,571 (555–2,583,544) 0.763† Values are presented as number, median (range), or number (%).
Load more

Recommended publications
  • Posttransplantation Lymphoproliferative Disorder After
    Original article JeongKorean HJ, J Pediatr et al. • 2017;60(3):86-93 Posttransplantation lymphoproliferative disorder after pediatric solid organ transplantation https://doi.org/10.3345/kjp.2017.60.3.86 pISSN 1738-1061•eISSN 2092-7258 Korean J Pediatr Posttransplantation lymphoproliferative disorder after pediatric solid organ transplantation: experiences of 20 years in a single center Hyung Joo Jeong, MD1, Yo Han Ahn, MD2, Eujin Park, MD1, Youngrok Choi, MD3, Nam-Joon Yi, MD, PhD3, Jae Sung Ko, MD, PhD1, Sang Il Min, MD, PhD3, Jong Won Ha, MD, PhD3, Il-Soo Ha, MD, PhD1, Hae Il Cheong, MD, PhD1, Hee Gyung Kang, MD, PhD1 1Department of Pediatrics, Seoul National University College of Medicine, Seoul, 2Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, 3Department of Surgery, Seoul National University College of Medicine, Seoul, Korea Purpose: To evaluate the clinical spectrum of posttransplantation lymphoproliferative disorder (PTLD) Corresponding author: Hee Gyung Kang, MD, PhD after solid organ transplantation (SOT) in children. Department of Pediatrics, Seoul National University Children’s Hospital, 101 Deahangno, Jongno-gu, Methods: We retrospectively reviewed the medical records of 18 patients with PTLD who underwent Seoul 03080, Korea liver (LT) or kidney transplantation (KT) between January 1995 and December 2014 in Seoul National Tel: +82-2-2072-0658 University Children’s Hospital. Fax: +82-2-2072-0274 Results: Eighteen patients (3.9% of pediatric SOTs; LT:KT, 11:7; male to female, 9:9) were diagnosed as E-mail: [email protected] having PTLD over the last 2 decades (4.8% for LT and 2.9% for KT).
    [Show full text]
  • Vocational Rehabilitation and End Stage Renal Disease
    DOCUMENT RESUME ED 260 193 CE 041 982 TITLE Vocational Rehabilitation and EndStage Renal Disease. Proceedings of theWorkshop (Denver, Colorado, December 11-13, 1979). INSTITUTION Emory Univ., Atlanta, GA. Regional Rehabilitation Research and Training Center.; GeorgeWashington Univ. Medical Center, Washington,DC. Rehabilitation Research and Training Center. SPONS AGENCY National Inst. of Handicapped Research(ED), Washington, DC.; Rehabilitation Services Administration (DHEW), Washington,D.C. Office of Human Development. PUB DATE (80) GRANT 13-P-59196/4; 16-P-56803/3 NOTE 114p. PUB TYPE Collected Works- Conference Proceedings (021) -- Viewpoints (120)-- Reports - Research/Technical (143) EDRS PRICE MF01/PC05 Plus Postage. DESCRIPTORS *Coping; *Counseling; Counseling Techniques; Postsecondary Education; VocationalEvaluation; *Vocational Rehabilitation; Workshops IDENTIFIERS *Dialysis; *Kidney Disease; SexualAdjustment ABSTRACT This document contains 12papers presented to medical and vocational rehabilitation professionalson the topic of vocational rehabilitation and End StageRenal Disease (ESRD) ata Denver conference in 1979. The followingpapers are contained in this report: "Rehabilitation and ESRD: Services witha New Thrust" by Kathleen E. Lloyd; "Medical Management ofthe ESRD Patient" by Alvin E. Parrish; "Hemodialysis--of Machine andMan" by Norman C. Kramer; "Adjustment to Dialysis--A Consumer Pointof View" by John M. Newmann; "Peritoneal Dialysis--Asa Long-Term Treatment Modality" by Michael I. SorkinTransplantation--New Directionsand Patient Selection" by Israel Penn; "Vocational Potentialof ESRD Clients" by Helen L. Baker; "A Comparison of Long-Term andShort-Term Hemodialysis Clients" by Dorothy J. Parker;"Utilizing Work Potential--Vocational Assessment and JobPlacement" by Sheldon Yuspeh and Kalisankar Mallik; "Sexual Adjustmentand ESRD" by Gary T. Athelstan; "Adjustment to Transplantation--AConsumer Response" by C. Norman Weaver; and "Counseling the ESRD Patientfor Vocational Planning" by Elizabeth Rose.
    [Show full text]
  • Indirect Evaluation of Estrogenic Activity Post Heterotopic Ovarian Autograft in Rats1
    12 - ORIGINAL ARTICLE Transplantation Indirect evaluation of estrogenic activity post heterotopic ovarian autograft in rats1 Avaliação indireta da atividade estrogênica após transplante heterotópico de ovário em ratas Luciana Lamarão DamousI, Sônia Maria da SilvaII, Ricardo dos Santos SimõesIII, Célia Regina de Souza Bezerra SakanoIV, Manuel de Jesus SimõesV, Edna Frasson de Souza MonteroVI I Fellow PhD Degree, Surgery and Research Post-Graduate Program, UNIFESP, São Paulo, Brazil. II Fellow Master Degree, Surgery and Research Post-Graduate Program, UNIFESP, São Paulo, Brazil. III Assistant Doctor, Gynecological Division, São Paulo University, Brazil. IV MS, Citopathologist, Gynecological Division, UNIFESP, São Paulo, Brazil. V Full Professor, Histology and Structural Biology Division, Department of Morphology, UNIFESP, São Paulo, Brazil. VI PhD, Associate Professor, Operative Technique and Experimental Surgery Division, Department of Surgery, UNIFESP, São Paulo, Brazil ABSTRACT Purpose: To morphologically evaluate the estrogenic effect on the uterus and vagina of rats submitted to ovarian autografts. Methods: Twenty Wistar EPM-1 adult rats were bilaterally ovariectomized, followed by ovarian transplants in retroperitoneal regions. The animals were divided in four groups of five animals, according to the day of euthanasia: G4, G7, G14 and G21, corresponding to the 4th, 7th, 14th and 21st day after surgery, respectively. Vaginal smears were collected from the first day of surgery until euthanasia day. After that, the vagina and uterus were removed, fixed in 10% formaldehyde and submitted to histological analysis and stained with hematoxiline and eosine. Results: All animals showed estrous cycle changes during the experiment. In 4th day, the uterus showed low action of estrogen with small number of mitosis and eosinophils as well as poor development.
    [Show full text]
  • Alumni-Today-Reunion-2015.Pdf
    Event Schedule FRIDAY SATURDAY HOTEL MAY 20, 2016 MAY 21 2016* ACCOMODATIONS 1:00 PM – 3:00 PM 8:00 AM – 8:45 PM 1. Blocks of rooms are reserved Tour Downstate Medical Center Annual Alumni until 5/6/16 at the Marriott NY and Kings County Hospital Business Meeting at the Brooklyn Bridge. Call 718.246.7000 or 1-888- 5:00 PM – 7:00 PM 8:45 AM – 10:45 AM 436-3759 and mention the Cocktail Reception NY Marriott Scientific Program “Alumni Association” to get at the Brooklyn Bridge (CME Credit) the special low rate. (All Classes) 2. Singles and doubles are 11:00 AM – 11:30 AM Cocktail Reception for $199.00 plus tax per night. Address to Aumni 5 and 10 Year Classes: John F. Williams, MD, EdD, MPH, 3. Valet parking is available for (2005 and 2010) and FCCM (Downstate president) a fee at the hotel. Graduating Class of 2016 11:30 AM – 1:00 PM DINNER DANCE Awards Ceremony Price: $250/person. * All activities on Saturday will be held A special price of $100/person 1:00 PM – 2:30 PM at the Marriott NY at the Brooklyn for Class of 2006 and 2011 Complimentary Luncheon Bridge, 33 Adams Street, Brooklyn. Special Diets available – fish, kosher, etc.; Seating requests 7:30 PM – 8:30 PM accomodated. Cocktail Hour TRANSPORTATION 8:30 PM – 12:30 AM Free transportation will be pro- DINNER DANCE vided on Friday afternoon taking people to and from the Medical School and Marriott NY at the Brooklyn Bridge. 2 | Reunion Issue CONTENTS 2015 4 Alumni Association President Greeting 5 Editor’s Greeting 6 New Executive Director Greeting 7 New Dean Greeting 9 The Alumni
    [Show full text]
  • Vaginal Probiotic Lactobacillus Crispatus Seems to Inhibit Sperm Activity and Subsequently Reduces Pregnancies in Rat
    fcell-09-705690 August 11, 2021 Time: 11:32 # 1 ORIGINAL RESEARCH published: 13 August 2021 doi: 10.3389/fcell.2021.705690 Vaginal Probiotic Lactobacillus crispatus Seems to Inhibit Sperm Activity and Subsequently Reduces Pregnancies in Rat Ping Li1, Kehong Wei1, Xia He2, Lu Zhang1, Zhaoxia Liu3, Jing Wei1, Xiaomei Chen1, Hong Wei4* and Tingtao Chen1* 1 School of Life Sciences, Institute of Translational Medicine, Nanchang University, Nanchang, China, 2 Department of Obstetrics and Gynecology, The Ninth Hospital of Nanchang, Nanchang, China, 3 Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Nanchang University, Nanchang, China, 4 Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China Background: The vaginal microbiota is associated with the health of the female reproductive system and the offspring. Lactobacillus crispatus belongs to one of the most important vaginal probiotics, while its role in the agglutination and immobilization Edited by: of human sperm, fertility, and offspring health is unclear. Bechan Sharma, University of Allahabad, India Methods: Adherence assays, sperm motility assays, and Ca2C-detecting assays were Reviewed by: used to analyze the adherence properties and sperm motility of L. crispatus Lcr-MH175, António Machado, Universidad San Francisco de Quito, attenuated Salmonella typhimurium VNP20009, engineered S. typhimurium VNP20009 Ecuador DNase I, and Escherichia coli O157:H7 in vitro. The rat reproductive model was further Margarita Aguilera, University of Granada, Spain developed to study the role of L. crispatus on reproduction and offspring health, using *Correspondence: high-throughput sequencing, real-time PCR, and molecular biology techniques. Tingtao Chen Our results indicated that L.
    [Show full text]
  • Actant Stories and the Australian Xenotransplantation Network
    Constructing and Fracturing Alliances: Actant Stories and the Australian Xenotransplantation Network Copyright - Neil Leslie, Wellcome Images; reproduced with permission Peta S. Cook BPhoto; BSocSc (Sociol.) (hons.) Humanities Research Program Queensland University of Technology Submitted in full requirement for the degree of Doctor of Philosophy 2008 “The XWP [Xenotransplantation Working Party] agree that, in retrospect, a sociologist would have been a useful addition to the group to help understand these issues” (Xenotransplantation Working Party 2004: 14, emphasis added). - i - Keywords sociology; xenotransplantation; transplantation; allotransplantation; actor-network theory; science and technology studies; public understanding of science (PUS); critical public understanding of science (critical PUS); scientific knowledge; public consultation; risk; animals - ii - Abstract Xenotransplantation (XTP; animal-to-human transplantation) is a controversial technology of contemporary scientific, medical, ethical and social debate in Australia and internationally. The complexities of XTP encompass immunology, immunosuppression, physiology, technology (genetic engineering and cloning), microbiology, and animal/human relations. As a result of these controversies, the National Health and Medical Research Council (NHMRC), Australia, formed the Xenotransplantation Working Party (XWP) in 2001. The XWP was designed to advise the NHMRC on XTP, if and how it should proceed in Australia, and to provide draft regulatory guidelines. During the period
    [Show full text]
  • Xenotransplantation of Ovarian Tissue Into Male
    XENOTRANSPLANTATION OF OVARIAN TISSUE INTO MALE IMMUNODEFICIENT MICE by HUGO JOSE HERNANDEZ FONSECA (Under the direction of BENJAMÍN G. BRACKETT) ABSTRACT A male immunodeficient mouse model for transplantation of ovarian tissue was investigated. Bovine and human ovarian tissues were surgically placed either under the kidney capsule or in the subcutaneous spaces of male non obese diabetic (NOD) severe combined immunodeficient (SCID) mice. Time intervals required for development of growing follicles were determined for neonatal and adult bovine ovarian tissue grafts. This interval was much shorter (P <0.01) in adult tissue than in one-week-old calf tissue, i.e. 55 vs 124 days. The increase in the proportion of growing follicles was coincidental with a decrease in the proportion of resting follicles. This increment in the growing follicle populations took place abruptly and was significant by 55 days and by 124 days after transplantation in the adult cow and calf ovarian grafts, respectively. Recovery of oocytes from bovine ovarian grafts was successful. Several immature oocytes were recovered and evidence of maturation in one oocyte was obtained after 24 hours of in vitro maturation. Treatment of host mice with an FSH:LH preparation increased follicular development but did not enhance oocyte recovery rates. Human ovarian tissue grafted under the kidney capsule of intact male NOD SCID mice showed a greater proportion of growing follicles than similar grafts transplanted to the kidney of castrated hosts and to the subcutaneous space of intact hosts. However, no differences in follicular growth and development were detected between the intact/ kidney capsule and the castrated / subcutaneous groups.
    [Show full text]
  • Kidney News Is Published by the American Society of Nephrology October 22 at 10:00 A.M
    Y WE E E K N E D I D K I T I N O October/November 2020 | Vol. 12, Number 10 & 11 Scrutiny Continues Over Use of Race in Estimated GFR By Eric Seaborg s calls for social justice and unrest reach into at risk for kidney disease,” Delgado said. “We have also been every corner of American life, the controversy charged with recognizing that any change in eGFR report- over the inclusion of race as a factor in calculat- ing must consider multiple social and clinical implications, ing estimated glomerular filtration rates reached be based on rigorous science, and be part of a national con- Amore milestones as ASN and the National Kidney Foun- versation about uniform reporting across healthcare systems. dation (NKF) formed a task force to reassess the practice, Those are just two of the five charges that we have gotten.” a congressional committee chair sought information from The task force includes 14 members with broad exper- medical societies about the use of race in clinical algorithms, tise in healthcare disparities, epidemiology, health services and more institutions moved away from the practice. research, genetic ancestry, clinical chemistry, patient safety The issue even hit the mainstream media with a story and performance improvement, pharmacology, and social from Consumer Reports, “Medical Algorithms Have a Race sciences, as well as two patients. Problem.” The recommendations will be vetted by an eGFR Advi- The NKF-ASN Task Force on Reassessing the Inclu- sory Board, Delgado said, and “go through a series of checks sion of Race in Diagnosing Kidney Disease is co-chaired by members of the nephrology community at large, includ- by Cynthia Delgado, MD, and Neil R.
    [Show full text]
  • Malignant Lymphoma of the Cervix in a Bicollis Uterus Considered to Be A
    Gynecologic Oncology Reports 34 (2020) 100676 Contents lists available at ScienceDirect Gynecologic Oncology Reports journal homepage: www.elsevier.com/locate/gynor Case report Malignant lymphoma of the cervix in a bicollis uterus considered to be a post-transplant lymphoproliferative disorder in a patient after renal transplantation: A case report Yu Yoshida *, Ririko Izumi, Saki Iwashita, Natsumi Nakashima, Kaori Kishida, Yuzo Imachi, Yukiyo Shimada, Kana Maehara, Tomoko Wada, Mariko Ando, Yoichiro Hamasaki, Shuichi Kurihara, Sachiko Onjo, Makoto Nishida Department of Obstetrics and Gynecology, Japanese Red Cross Fukuoka Hospital, 3-1-1 Ohgusu, Minami-ku, Fukuoka 815-8555, Japan ARTICLE INFO ABSTRACT Keywords: Post-transplant lymphoproliferative disorder (PTLD) refers to a group of diseases, characterized by abnormal Malignant lymphoma proliferation of lymphocytes, that develop after organ transplantation. PTLD is associated with poor prognosis, Cervix and has become a major problem for transplant patients. In this report, we described a case of malignant lym­ Bicollis uterus phoma of the cervix in a bicollis uterus considered to be a PTLD in a patient after renal transplantation. The Renal transplantation incidence of this disease is expected to increase as the survival rate of transplant patients improves. Hence, it is Post-transplant lymphoproliferative disorder very important for gynecological oncologists to consider the presence of PTLD when examining such patients. 1. Introduction right cervix was normal in appearance; however, the left cervix was replaced with an easily bleeding mass (Fig. 1A, B). Pelvic examination Post-transplant lymphoproliferative disorder (PTLD) refers to a revealed that the bilateral parametrium was not indurated. Transvaginal group of diseases, mainly characterized by abnormal proliferation of ultrasound evaluation showed a hyperechoic tumor in the left cervix, lymphocytes that develop after organ transplantation.
    [Show full text]
  • First Successful Delivery After Uterus Transplantation in MHC-Defined
    Journal of Clinical Medicine Article First Successful Delivery after Uterus Transplantation in MHC-Defined Cynomolgus Macaques Iori Kisu 1,* , Yojiro Kato 2, Yohei Masugi 3, Hirohito Ishigaki 4 , Yohei Yamada 5 , Kentaro Matsubara 6, Hideaki Obara 6, Katsura Emoto 3, Yusuke Matoba 1, Masataka Adachi 1, Kouji Banno 1, Yoko Saiki 7, Takako Sasamura 4, Iori Itagaki 8, Ikuo Kawamoto 8, Chizuru Iwatani 8, Takahiro Nakagawa 8, Mitsuru Murase 8, Hideaki Tsuchiya 8, Hiroyuki Urano 9, Masatsugu Ema 8, Kazumasa Ogasawara 4, Daisuke Aoki 1, Kenshi Nakagawa 9 and Takashi Shiina 10 1 Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 1608582, Japan; [email protected] (Y.M.); [email protected] (M.A.); [email protected] (K.B.); [email protected] (D.A.) 2 Department of Surgery, Division of Gastroenterological and General Surgery, School of Medicine, Showa University, Tokyo 1428555, Japan; [email protected] 3 Department of Pathology, Keio University School of Medicine, Tokyo 1608582, Japan; [email protected] (Y.M.); [email protected] (K.E.) 4 Department of Pathology, Shiga University of Medical Science, Shiga 5202192, Japan; [email protected] (H.I.); [email protected] (T.S.); [email protected] (K.O.) 5 Department of Pediatric Surgery, Keio University School of Medicine, Tokyo 1608582, Japan; [email protected] 6 Department of Surgery, Keio University School of Medicine, Tokyo 1608582, Japan; [email protected] (K.M.); [email protected] (H.O.) 7 Department of Anesthesiology, Saiseikai Kanagawaken
    [Show full text]
  • Incidence, Risk Factors and Outcomes of De Novo Malignancies Post Liver Transplantation
    Submit a Manuscript: http://www.wjgnet.com/esps/ World J Hepatol 2016 April 28; 8(12): 533-544 Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx ISSN 1948-5182 (online) DOI: 10.4254/wjh.v8.i12.533 © 2016 Baishideng Publishing Group Inc. All rights reserved. TOPIC HIGHLIGHT 2016 Liver Transplantation: Global view Incidence, risk factors and outcomes of de novo malignancies post liver transplantation Pavan Kedar Mukthinuthalapati, Raghavender Gotur, Marwan Ghabril Pavan Kedar Mukthinuthalapati, Raghavender Gotur, 7 fold higher, age and gender adjusted, risk of de Marwan Ghabril, Division of Gastroenterology and Hepatology, novo malignancy. The overall incidence of de novo Indiana University School of Medicine, Indianapolis, IN 46202, malignancy post LT ranges from 2.2% to 26%, and United States 5 and 10 years incidence rates are estimated at 10% to 14.6% and 20% to 32%, respectively. The main Author contributions: Mukthinuthalapati PK interpretation risk factors for de novo malignancy include immuno- of literature, drafting and final approval of the article; Gotur R suppression with impaired immunosurveillance, and interpretation of literature, drafting and final approval of the a number of patient factors which include; age, article; Ghabril M interpretation of literature, drafting and final approval of the article. latent oncogenic viral infections, tobacco and alcohol use history, and underlying liver disease. The most Conflict-of-interest statement: All the authors have no common cancers after LT are non-melanoma skin conflicts to report. cancers, accounting for approximately 37% of de novo malignancies, with a noted increase in the ratio of Open-Access: This article is an open-access article which was squamous to basal cell cancers.
    [Show full text]
  • Uterus Transplantation and Ovarian Cryopreservation for Fertility Reconstruction in Female Genital Cancer Patients
    QOL after childhood cancer therapy -Cutting-edge researches on fertility preservation- Collaboration Reconstructive surgery * Transplantation surgery Uterus transplantation and ovarian cryopreservation for fertility reconstruction in female genital cancer patients Halim Ahmad Sukari1, Takashi Nakagawa2, Shuhei Noguchi2,, Makoto Mihara2 1Reconstructive Sciences Unit, School of Medical Sciences, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia 2Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Japan (Received 5 May 2009; accepted 8 June 2009) Abstract Recently, a therapy aimed to preserve fertility has been developed for patients with female genital cancer. However, carcinoma excision needs to be performed for cases of advanced disease stage at the expense of fertility. We have been conducting an ovarian cryopreservation study and uterus transplant study under immunosuppression in an attempt to reconstruct fertility in patients with a radical hysterectomy due to advanced disease. It may seem to be too early to expect clinical application of a uterus transplant study at this stage of development because many ethical and legal problems remain to be solved. However, we believe it is very important to raise the possibility for those patients undergoing radical hysterectomy to have babies by cryopreserving a part of the removed ovary so that IVM-IVF (in vitro maturation-in vitro fertilization) technique may be adopted in the future when the technology advances to the point of achieving a mature ovum from an oogonium. We aim at safe fertility reconstruction in patients who had a hysterectomy due to uterine cancer by establishing a new uterus transplant based on an effort to integrate Super-Microsurgery, an advanced vascular anastomosis technique in the plastic surgery and reconstructive surgery field, and organ transplantation under immune tolerance, an advance in the transplantation surgery fi eld.
    [Show full text]